UL The Neurodynamic Techniques 5 ay fs. 5 ia ia i Q iz pbWith thanks to... NOT Faculty members Translators - Ruggero Strobbe (Italian), Stefan Schiller and Margot Bauer-Mitteriehner (German), Henry Tsao and Mei-Chun Kuo Tsao (Chinese Mandarin), Benito Cao (Spanish). Models - Ciaire, David and Rookie Design - Ariane Allchurch, Dinah Edwards Production manager - Juliet Gore ‘Anatomy artwork - Copyright (2005), Icon Learning Systems, LLC. & subsidiary of MediMedia, USA, Inc. All rights reserved DVD authoring - Anthony James Spectra Videographics, spectravideogfx@hotmail.com, Reproduction - Microview Solutions Chatswood NSW, Australia, www.microview.com.au Printing - van Gastel Printing, Adelaide, Australia ‘Music - Meria by Miguel Espinoza EEL Nine key points Introduction This neurodynamics techniques OVD ‘and book hes been produced by the Neuro Orthepaedic Institute ‘Australasia, with contributions from ‘our international faculty. It is ‘expected that users will be health professionals, and thus will have an existing knawledge of neuroanatomy and neuro orthopaedic assessment plus knowledge of relevant pathology, precautions and contraindications. Our international faculty NOI instructors are hand selected on the basis of thelr existing skills and expertise and undergo rogressive peer and expert training. All instructors have postgraduate manual therapy educations and are members of national associations and of the International Association for the Study of Pain. ‘Our courses taught in languages other than English ‘are predominantly delivered by native speaking members of the Faculty, NNOI's faculty members all travel widely to meet their teaching commitments, Australia David Butler, Peter Barrett, Carolyn Berryman, Michel Coppieters and Megan Dalton, Europe - German speaking Gerti Bucher-Dollenz, Martina Egan-Moog, Hannu Luomajoki, Harry von Piekartz, Hugo Stam and Irene Wicki Europe - Italian speaking Sergio Parazza, Erika Schiffereger, Ruggero Strobbe, ‘Susanne Wabrlich and Irene Wick! usa ob Johnson, Adriaan Louw, Bab Nee, Stephen Schmidt and John Tombertin, ca ‘Sam Steinfeld and Laurle Urban. 1 > what is a neurodynamic test? Neurodynamics is the science of the relationships between mechanics and physiology of the nervous system. Simply put ~ It is the assessment and treatment of the physical health of the nervous system. Just as a joint moves and a muscle stretches, the nervous system also hes physical propertics that are essential for movement. You can examine these properties via nerve palpation and neurodynamic tests. 2 > The nervous system is a continuum ‘A mechanical, electrical and chemical continuum exists in the nervous system. This Is the basis of tests such as the slump test, where for example, the position of the neck will Influence neural responses in the leg For optimal and safe clinical integration, itis highly recommended that this DVD and book be used in ‘association with NOT education ‘seminars (www.noigroup.com) and/or used with the textbooks Mobilisation of the Nervous System or preferably, The Sensitive Nervous System, This DVD and book should not be taken as just a list of exercises, but more a series of ideas. For example, techniques may be demonstrated to illustrate @ particular principle for one nerve, but similar techniques could be used for other neural structures. 3 > structural differentiation ‘The neural continuum allows a differentiation between neural and non- neural tissues. For example, in the case of the slump test (see below), if neck extension which takes load off the nervous system eases evoked ‘symptoms in the leg, then this provides some clinical data to suggest that there is a physical health issue | in the nervous system. | =4 > Neural relations to joint axes dictates load ‘The nervous system is usually behind, in front, or to the side of joint axes of movement. This ‘means that the physical loading fon the nervous system will be dictated by joint position. In the example shown of the Upper Lim Neurodynamic Test (ULNT), wrist extension, elbow extension, and shoulder abduction would be examples fof movements which challenge the median nerve and the brachial plexus. If you know your anatomy, you could make 6 > order of Movement ‘The strain and movement cf the nervous system will be affected by the order in which the movement 's taken up. For example, as illustrated, if you add ankle dorsiflexion and eversion and then perform a ‘Straight Leg Raise (SLR) , a neurogenic problem in. the tibial nerve at the ankle Is mare likely to be ‘exposed than with other combinations, ‘There are probably two reasons for this: a more mechanical reason where the neural tissues are “vorrawed’ from other areas and thus given more ‘of @ chance to be challenged, or perhaps the first movement is the one which takes priority In the up neurodynamic tests yourself 5> 1ch and tension - the key role of neighbouring structures Most neurodynamic tests are tests ofthe abilty of the nervous system to elongate. The neighbouring structures (e.g. Joint and muscle) which “contain’the nervous system 2. W) can sometimes pinct i. Wrist flexion Isa test ofthe neural DBM container aroun the median nerve atthe carpal tunnel, Ta 4 Patient's consciousness. and the Spurling’s test (ilustrated here) is an example ~ of a pinch test for lower ‘cervical nerve roots. PETIT T TOT 7 > Sliders and tensioner ‘A tensioner (1) can be a vigorous technique ‘which ‘pulls from both ends’ of the nervous system. A slider (2) is a flossing’ movement where tension Is placed at one end of the system and slack at the other. Sliders ravide a large amount of neural movement and are a neurally nonaggressive moverent for anxious patients. ov 8 > Recording ‘Abbreviations such as PF/IN/SLR inform the order and kind of movement, thus ankle plantar flexion first, then Inversion and then Straight Leg Raise. Each component can also be quantified in terms of range of ‘movement or qualified in terms of symptoms evoked. ‘The ‘In:Did’ system Is also used. For ‘example, In: HF/LR Did: KE means that in the hip flexion and lateral rotation position, knee extension was performed. Q > Don't forget the brain Remember that responses to these tests ‘may not always be due to physical health Issues in the nervous system. In some patients the sensitivity evoked during testing ‘may be due to changes in the central nervous system. There is much more on this Important part of assessment in The Sensitive ‘Nervous System,Glossary References “seer C/T... Cervico-thoracie Butler DS (2000 The Sensitive Nervous Dorsifiexion System, ISBN 0°646-40251-X, Eversion NOI Publications, Adelaide. Glenohumeral a "Hip abeucion Butler DS (1991) Mobilisation of the Hip adduction ‘Nervous System, ISBN 0-443-04400-7, Hip extension Churchill Livingstone, Melbourne. Hip flexion {Also In German, Italian, Spanish and Japanese.) * intermetatarsal Inversion i Iverson an Support material Knee flexion NOY’ list of self published literature and brain products is {tera flexion continually updated and expanded. Visit nalgroup.com for Lateral rotation detalled descriptions and secure online ordering Longsitting Penta eon Noigroup.com Prone Knee Bend Passive Neck Flexion Radial Slump Knee Bend slider Straight Leg Raise ‘An active network for reviews, case studies, relevant research data, reference lists, international course schedules in English ‘and other languages, discussion forum and feedback page, resources, product sales, booklist with links to booksellers. Become a member of the NOI network by completing the membership form at www.nolgroup.com or by emailing your ekmne|cong. sit fetails to noi@noigroup.com. Slump sidelying detalls to nei@noigroup.com. SP. Spinal ‘Sup TF. Superior tibionbular ten. tensioner Thx |. Thorax ULNT | Upper Limb Neurodyramic Test PEE OQ QQ QGG DCO 0ee Peroneal nerve dae opm scctseumerneeussss¢h eames apd " ° a oe swing heel to floor. . . 14 In: Slump LS/PF/IN Did: Sup TF mob - KE ...-- 6.4 Ss management > si sas uovernents In: HF/PF/IN Did: KE : cerns 5 In: HF/DF/EV Did: KE + strap ‘Wall work’ . 15, Leg swing toes curled under. " 7 In: Slump LS/DF/EV Did: KE (sli/ten) . a 16, Wall mobilisation. evens s Sural nerve i . rene Tibial nerve Passive techniques: ‘Anatomy and palpation Int HE/DF/IN Did: KE. seeseeee ee eeeee eee D9 Therapist’s assessment In: DF/IN Did: nerve massage -